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Posts Tagged ‘global health’

The Obama administration today released a government-wide strategy on a subject that previously had drawn little high-level attention from Washington – the Millennium Development Goals, or MDGs.

Much like National Security Strategy documents put together by a succession of U.S. administrations, Obama’s MDG strategy serves as more of a framework of principles, rather than giving specific details on how the U.S. government will help developing countries reach the goals by 2015.

Some of the most prominent MDGs are eradicating extreme poverty and hunger, reducing child mortality, and improving maternal health.

“We just think it’s a tremendous opportunity to have the US engage proactively in the MDG dialogue with some fresh ideas,’’ said Ben Hubbard, deputy chief of staff at the U.S. Agency for International Development, in an interview with Science Speaks. “We are 10 years in, and five to go. We looked at the data, and asked ourselves what is needed to get to the finish line and what the U.S. can uniquely contribute.’’

The strategy, which was released today in an invitation-only gathering in Washington with no press coverage, comes two months before the United Nations will hold meetings on MDG progress.

It lists significant achievements as well as miserable failings in countries. (more…)

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Starting today, we here at Science Speaks are going to try something new: Every Wednesday, we are going to feature stories from around the blogosphere and elsewhere that we have been reading – and that we believe will be of interest to you.

Because this is something new for us, any feedback you have would be much appreciated. And please do not hesitate to make suggestions for future posts!

  • The new issue of The Lancet features a number of stories on TB, including some focusing on HIV/TB coinfection, XDR-TB, and tactics for addressing the epidemic. (more…)

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This posting is by Rabita Aziz, Program Associate at the IDSA/HIVMA Global Center

The new report by the Center for Strategic and International Studies (CSIS) Commission on Smart Global Health Policy  calls for the U.S. to double contributions to better maternal and child health, to $2 billion a year.  Such investments should be focused on a few core countries in Africa and South Asia where there is a clear need, where partner governments are willingly engaged, and where concrete health gains can be made along with increasing a country’s capacities.

The report demonstrates that maternal mortality is a profound problem by offering this data: a woman’s risk of dying in pregnancy or childbirth is 1 in 7,300 in the industrialized world, 1 in 120 in Asia, and 1 in 22 in sub-Saharan Africa.  Although there are clear preventative solutions in many of these cases, accessing such measures is problematic.

The report states that improving maternal mortality requires an interlinked set of interventions that are supported and sustained over time, including heightened efforts to improve local transport.  In addition to addressing maternal mortality, it is imperative that efforts to end child and infant mortality are undertaken.  The report states that it is estimated that a package of 16 simple and cost-effective measures could prevent nearly 3 million of the estimated 4 million deaths in the first month of life.  Additionally, expanding access to immunizations can save the lives of 2 million children under the age of five.

Although the report clearly states that maintaining America’s commitment to fighting against HIV/AIDS is one element in a global health strategy, it fails to integrate this commitment within the framework of strengthening maternal and child health.

Globally, HIV/AIDS is the leading cause of death among women of reproductive age.  When half of the 31.3 million people living with HIV worldwide are women, and 98 percent of them reside in developing countries, the importance of envisioning HIV/AIDS as a maternal and child health issue is clear.  Integrating HIV/AIDS efforts within efforts to improve maternal and child health, and scaling them up, is key to a rights-based approach to health.

Among pregnant women in Johannesburg, South Africa’s most populous city, HIV is the main cause of death, according to a five-year study of maternal mortality at one of the city’s largest public hospitals

It is also important to recognize that HIV-negative children born to HIV-positive mothers still face high mortality risks as long as their mothers are not receiving treatment.   A Ugandan study found that not only is there a 95% reduction in mortality among HIV infected adults after 16 weeks of antiretroviral treatment, but there is an 81% reduction in mortality in their uninfected children younger than 10, and an estimated 93% reduction in orphan hood.[1]

Unfortunately, there is no mention in the report of undertaking initiatives to reduce the prevalence of HIV/AIDS among women and ensure access to treatment as a key maternal health strategy, even though it is clear that taking such measures will greatly strengthen families and communities.  Prevention of mother to child transmission of HIV is imperative, as well as ensuring access to ongoing treatment for the mother.


[1] Mermin et al (2008) Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study Lancet 371: 752-759.

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The Center for Strategic and International Studies yesterday unveiled  a new “must-read” report for global health advocates, “Smart Global Health Policy.” While a panel at the Congressionally-chartered Institute of Medicine, made up primarily of scientists, issued recommendations on US global health policy last year, the CSIS panel is the first to involve high-level business leaders and sitting members of Congress.

The report drew on observations made during a study trip to Kenya, but it is unclear if consultation in developing countries went beyond that, for instance to include global representatives of affected communities and of developing country civil society, such as those on the boards of UNITAID and the Global Fund.

The report and the webcast of the launch event are available online.  Here are a few highlights:

The report makes a strong case that it is in the interest of the United States to continue and increase  our investment in global health and that the issue should matter to all Americans. It calls for keeping funding for AIDS, TB and malaria on a “consistent trajectory,” doubling spending on maternal and child health to $2 billion a year, forging a collaborative response to emerging heath threats, establishing strong coordination of global health policy across US agencies, and increasing support for multilateral efforts.

In 2009 there was a massive drop off in the expansion of treatment by US programs, and the report notes that AIDS advocates are “particularly anxious” at the slowing growth rate, a stalling that could also impact health systems.  The report suggests that funding is a concern for treatment advocates, yet, in fact, HIV prevention advocates have also been quite alarmed at the essentially flatline funding picture.

Despite World TB Day (March 24) being just a few days away, no mention is made in the report of immediate tuberculosis funding concerns, lowered TB targets in the 6-year Global Health Initiative or USAID’s role in responding to TB.  Instead, the report includes TB within a much longer timeframe, stating that “we can accomplish great things in the next 15 years:  We can cut the rate of new HIV infections by two thirds, end the threat of drug-resistant tuberculosis, and eliminate malaria deaths.”

In terms of overall funding, the report calls for less spending in the near term than either the IOM panel or the Global Health Initiative coalition did; instead, the CSIS document endorses the President’s proposed funding of $63 billion by 2014.  While the IOM called for specific increased funding levels on AIDS, TB and malaria consistent with Lantos-Hyde, the CSIS report does not delve into specific funding levels, with the exception of maternal and child health.  Instead, taking the long view, it calls for $25 billion in annual spending by 2025.

One exciting aspect of the CSIS report is that it endorses innovative financing as a means of raising funds for global health.  The report does not touch on the concept of innovative taxation for health, recently championed by maternal health advocates at Family Care International and many other groups. However, it identifies some specific mechanisms, such as borrowing the money needed through an international finance facility, and it urges the US National Security Council to review the most promising ideas on innovative financing and develop a US position.

Admiral William J. Fallon kicked off the launch event, stating that global health is a “bipartisan enterprise… which can unite US citizens in collective action.”  He stated the importance of maintaining forward momentum, noting that “we do not want to coast or slide backward.”  Helene Gayle said that global health efforts are showcasing the American spirit of generosity and said “we need forward momentum even in a period of constrained resources.”

Jack Lew, the top State Department official developing the US Global Health Initiative, spoke about the Administration’s goals in developing the new strategy. He said that the Administration’s aim was to “challenge a way of doing business by moving beyond a primary focus on disease treatment.”  He said the goal was “not to do harm to existing programs.”

Advocates for effective HIV prevention have felt stymied in recent weeks by the lack of specific HIV/AIDS guidances from the Administration to the field and have noted that Kenya’s Partnership Framework with the US even appears to rule out family planning integration.  Family planning came up at the event when Dr. Michael Merson, of Duke University, criticized the Canadian government’s rejection of the inclusion of family planning as a part of its maternal health initiative.

But Lew’s presentation did not delve into details — and there was no opportunity at the event for questions from the floor.  He stated that program integration was crucial to meet the needs of women, and he commented on the importance of having family planning and HIV/AIDS services in one location.

The report is particularly noteworthy for the very strong focus on measurement for accountability in delivering services. Business leaders at the event decried the reporting burden on health programs and, along with Dr. Merson, called for a common set of impact indicators.

Rajeev Venkayya, Director of Global Health Delivery at the Bill and Gates Melinda Foundation, said that measurement matters because it allows us to maximize efficiency and stretch dollars while identifying what works and what doesn’t.  In addition, measurement allows us to hold accountable institutions, organizations, and even individuals, which in turn allows for greater project improvement.  Exxon Mobil Chairman and CEO Rex Tillerson agreed, and cited a Lancet article which said that evaluation must be a top priority for global health.

Robert Rubin, former US Treasury Secretary and former head of Citigroup and Goldman Sachs, told the audience that global health leaders “face wrenching choices” as a result of US fiscal problems.  He asked two members of Congress, Rep. Keith Ellison and Senator Jeanne Shaheen, whether global health is an issue that can “break through the mire” on Capitol Hill.

Senator Shaheen said that the issue can succeed, but it is crucial to explain to Americans that international affairs spending is only a tiny fraction of the US budget, much less than people realize.   She said it was cheaper to spend on global health than on war, noting Bill Clinton’s recent statement about the appreciation of PEPFAR expressed by Muslim residents of Tanzania.  She also said the current committee structure in Congress is an impediment and endorsed the recommendation included in the report for a consultative body that would work across committees.

Congressman Ellison also voiced strong support for greater US action on global health, stating that “infectious diseases know no borders.”  He said that while in Kenya, he made good progress in persuading Kenyan leaders of the necessity of stepping up their own contributions.  He suggested that by reducing US spending on outmoded weapons systems the US could improve its budget outlook and make global health spending easier.

Gayle Smith, the NSC official leading the development of the US Global health Initiative, was the concluding speaker at the event. She said global health was a bipartisan issue and that in fact President Obama specifically directed that the achievements of the previous Republican Administration be recognized.  She praised the CSIS report, and said that its ideas were remarkably congruent with those of the Administration.

She said the Administration’s commitment to fighting global HIV/AIDS was “absolute” and, she added, “this will grow over the life of the initiative.” She said the Administration’s plans for the Global Health Initiative “include an ambitions set of targets in terms of outcomes.”

She did not respond to concerns submitted to the Administration by the Global Center, TAG, the Global Health Council, and the GHI Working Group that the Administration’s targets regarding tuberculosis contradict a directive from Congress approved in 2008 as a part of Lantos-Hyde.  In fact, it was surprising that the event unfolded without  reference  to the consultative process which numerous NGOs have engaged in regarding the US Global Health Initiative or to the detailed analyses these groups have submitted to the Administration.

There were a range of reactions from health NGOs to the event.  Eric Friedman at Physicians for Human Rights noted the “surprisingly little attention in the report to human resources for health and health systems, and no mention of including civil society in the development of country compacts.” He praised the report for “proposing that the Administration develop a long-term, 15-year framework for making progress in and committing the United States to improving global health, a good idea so long as it does not set the stage for underambition, and is flexible to respond to changes in the years ahead. ” He also would have liked to see “a recommendation that the United States should deliberately integrate a right to health approach throughout U.S. global health programs, including the consistent focus on equality, accountability, and participation that this entails.”

Matt Kavanagh at Health GAP praised what he heard from the report, which included an emphasis on keeping up the fight against HIV/AIDS, especially important for the health of African women. But he noted with concern that “some of the Administration comments that seemed to favor prioritizing ‘cheap’ interventions that do not work in the long term, such as single dose nevirapine instead of treatment for HIV positive mothers, an approach abandoned long ago as ineffective in wealthy nations.”

The American Medical Students Association’s Farheen A. Qurashi said that the report “takes a bold, but necessary, approach to U.S. global health planning by insisting upon a 15-year comprehensive plan.”  She said, “Unfortunately, the Commission’s report does not appear to specify the need for scaling-up of PEPFAR investments versus the dangers of flat-funding, and instead uses language that suggests that a continuation of current levels of funding without annual growth is sufficient.”

On health systems, she said that “though integration and health systems strengthening is mentioned in general terms, and the need for training and retention of health care workers is noted, there is no detailed analysis of the measures, funding, and support necessary to establish and retain adequate numbers of health professionals and other health care workers.”

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Okay, so funding for PEPFAR and TB programs did not get top billing in tonight’s State of the Union address. With the economy still sputtering, with voters anxious about the next paycheck and angry about spiraling deficits, global health wasn’t exactly a political winner in tonight’s speech.   

But President Obama still did squeeze in a mention of the issue, even specifically citing US efforts to combat HIV/AIDS, highlighting a “new initiative” against bioterrorism and infectious diseases, and articulating a commitment to strengthening “public health abroad.”  Obama’s quick rhetorical nod came amid deep worry among HIV experts and activists about this Administration’s commitment to maintaining scale-up of treatment for AIDS–anxiety that was only deepened today by some news out of South Africa.

Here’s what Obama said tonight about America’s role  in foreign aid in general and  global health in particular:

“That is the leadership that we are providing – engagement that advances the common security and prosperity of all people. We are working through the G-20 to sustain a lasting global recovery. We are working with Muslim communities around the world to promote science, education and innovation.

We have gone from a bystander to a leader in the fight against climate change. We are helping developing countries to feed themselves, and continuing the fight against HIV/AIDS. And we are launching a new initiative that will give us the capacity to respond faster and more effectively to bio-terrorism or an infectious disease – a plan that will counter threats at home, and strengthen public health abroad.

As we have for over sixty years, America takes these actions because our destiny is connected to those beyond our shores. But we also do it because it is right.” (For full text, click here.)

These few words were welcome, particularly coming on the heels of a disconcerting story about of South Africa today, in which a US official warned of deep cuts to US global AIDS funding. 

“US government funding is going to come down dramatically over the next five years,” warned Dr Roxana Rogers, USAID South Africa Health Team leader last week, according to this story. “There is not a friendly feeling in the US towards more funding for HIV/AIDS,” Rogers told a meeting in Cape Town on the future of US assistance for HIV/AIDS, hosted by the US-based Council on Foreign Relations. Here’s a link to that full story.

US officials tried to quickly to “correct the record” by issuing this statement, which says the US is “fully committed to the multi-party effort led by the Government of South Africa to fight HIV and AIDS in South Africa” and adding these funding figures: “In South Africa, PEPFAR support from 2004-2009 has totaled over $2 billion (R15 billion), representing the largest contribution from PEPFAR to any country.  In 2010, PEPFAR will add $559 million (R4.2 billion) to the cause in South Africa. “

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Physicians on the front lines of the global tuberculosis epidemic have faced an uphill battle against this deadly scourge, especially with the rise of virulent new drug-resistant strands of this ancient germ and outmoded drugs and diagnostics.

But the medical landscape for TB could change dramatically in the coming years—with new tests and better drugs paving an easier path for TB treatment and care. That upbeat assessment comes from William Burman, MD, an TB specialist and associate professor of medicine at the University of Colorado, speaking at a global health news conference during the Infectious Diseases Society of America’s 47th Annual Meeting last weekend.

“We could have new TB drugs approved by 2011,” said Dr. Burman, who is also a member of the Global Center’s Scientific Advisory Committee. Two drugs currently in the pipeline look particularly promising, he said, because they work in new ways and appear to be very potent.

Those drugs and others in development, along with exciting new tests that could make tuberculosis diagnosis faster and easier, have the potential to “revolutionize the treatment of tuberculosis,” Dr. Burman said. “We can start to see the outlines of major improvement for TB treatment for patients,” with shorter therapy and possibly safer therapy too.

Dr. Burman said he sensed a renewed commitment in the US and other countries to TB research and treatment, a much-needed shift for this often-neglected forgotten disease. But he noted that the scope of the threat is still grave, with 9 million new TB cases a year and more than 1 million deaths, including an estimated 100,000 children who die from TB annually. Drug-resistant TB is of particularly concern, since it is extremely hard to diagnose and treat with the medical weapons currently available.

“The message is that this is a time of great need,” he said. And “it’s also a time of great opportunity.”

There was no similar talk of turning the corner in the battle against global HIV/AIDS at the news conference. Instead, two HIV/AIDS physician-experts said the gains made in the last decade against this deadly epidemic are tenuous, and developing countries could all too easily lose ground if leadership and resources wane. (more…)

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What will come of Anthony Fauci’s call for a “transformative” research agenda for tuberculosis, in which doctors and scientists get new resources and support in the search for better drugs and diagnostics to combat this ancient scourge?

Fauci, head of the National Institute of Allergy and Infectious Diseases, delivered that appeal for a more aggressive approach to TB last summer, during the Pacific Health Summit meeting in Seattle on the growing threat of drug-resistant TB. The Pacific Health Summit just issued this report on that meeting, providing a fresh reminder of Fauci’s stirring remarks.

“Why don’t we have 30 new drugs for tuberculosis, a disease that we know is eminently curable?” Fauci asked in an opening speech to leaders at the summit. One reason, he suggested, is that “a transforming research effort has not been evident…we are seeing the winds of change, but what we really need is a storm.”

Part of the reason we might not get that storm is highlighted in this very interesting post on scienceline.org about low TB rates in the U.S. and how they may provide false reassurance that TB is not a real (or close) threat. That item includes a great poster from a 1920s public health campaign against TB–the kind of campaign that Dr. Robin Wood talked about during his visit to Washington last week. Click here and here to read more on that.

That blog item and the Pacific Health Summitt report come just as TB gets some needed attention on Capitol Hill, where a Congressional briefing scheduled for tomorrow will focus on “how U.S. investment in global health research has advanced” the scientific quest for more effective TB treatment strategies. Click here to get more info on that event.

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